Okay, I admit it. I’m 43 years old and I can’t party like I used to. I needed a little help yesterday morning after ZOLL SHOCKFEST. But, I had an important meeting to attend with three amazing women who keep the trains running on time at EMS Today 2015 –Â MaryBeth DeWitt (@dewittmarybeth), Deborah Murray, and Amanda Brumby (@AmandaBrumby). It was really nice to put faces to names and share thoughts and observations about education, event planning, and social media. A.J. is incredibly fortunate to have these capable, professional women working behind the scenes to make EMS Today 2015 a success!

Exhibit Hall

From there Kelly (@barefootNurse24) and I headed down to the Exhibit Hall to take in the sights and chat with old friends. I had planned on catching up with Matt Fiske from Physio-Control (@PhysioControl) but he was recalled back to Seattle so I shared a life-saving story with John Friederich involving a Lifepak 12, a wedding party, and a Boy Scout and got myself a nice challenge coin!

Pediatric Resuscitation

I had the pleasure of meeting EMS 10 Award winner Peter Antevy M.D. (@Handtevy) at the EMS 10 Awards this year we hit it off right away. My departmentÂ has recently developed a beta version ofÂ Pediatric Pit Crew CPR and we recently pulled the Broselow bags (but not the Broselow tapes) off the ambulances — which was controversial — so it was really interesting when Peter started challenging me and asking me how I would accomplish various things like mixing up D25.

I was really enjoying the dialog, but it was the end of the night, so I gladly accepted when he invited me to attend at least one ofÂ his classes.

Psychological Wiring and Pediatric Resuscitation

I spend a lot of timeÂ thinking about human performance, team dynamics, and decision making under stress, so this presentation really hit home with me!

At a time when Adult Pit Crew CPR has swept the nation, EMS is working adult sudden cardiac arrest on scene for at least 20 minutes prior to transport, and survival rates have increased nationally, why have survival rates for pediatric cardiac arrest remained flat?

If you’re like me, you might say, “becauseÂ pediatric cardiac arrest is notÂ like adult sudden cardiac arrest — it’s more likely to be asphyxial — and the prognosis is not as good in the first place.” But there’s more to that story.

Let’s be honest. WhatÂ do we tend to do with kids? We scoop and run. Why do we do this when we know that it’s bad? We do it because it’s really scary, we’re not comfortable, andÂ we become overwhelmed.Â Dr. Antevy persuasively argues that this is perfectly normalÂ human behavior. Specifically, it has to do with System 1 and System 2 thinking.

System 1

Fast

Automatic

Frequent

Emotional

Stereotypic

Subconscious

System 2

Slow

Effortful

Infrequent

Logical

Calculating

Conscious

By making pediatric cardiac arrest so “different” from adult sudden cardiac arrest (to the point where the AHA has an entirely separate course for it), by requiring us to perform math under stress, and because we have to perform under the watchful eye of highly concerned parents, our System 2 thinking is easily overwhelmed. When that happens, we revert to System 1 — we all do — there are no exceptions.

When you revert to System 1 under stress you are no longer thinking rationally. You are reacting instinctively and you will ignore whatever you have to ignore (including logic or good advice) to extract yourself from the crisis. As a side note, this finally helps me understand why so many EMTs and paramedics are quick to separate children from parents (which has bothered me for a long time).

Once we understand System 1 and System 2 thinking, and once we admit that System 2 thinking is useless in an emergency situation, we can begin to develop effective System 1 strategies to ensure that our actions are helpful during an emergency. One of the ways we can do that is make pediatric resuscitation more like adult resuscitation.

A – Airway

B – BVM

C – Compressions

D – Drill (IO)

E – Epinephrine

Importantly, WE MUST ELIMINATE MATH. One of my most popular tweets this week was this quote from Dr. Antevy: “I’m really good at math. I’m terrible at math during a code.” Some of us aren’t veryÂ good at math in the first place.

Pediatric Calculations Made Simple

When you actually start going through scenarios it doesn’t take long to realize that those of us who do not work in pediatrics every single day have no idea how to accurately calculate, draw up, and administer medications to children safely. In many cases, we don’t even have the correct equipment to make it happen (and I’m talking about the equipment inside the Broselow bag).

Try this experiment next time you’re at work. Find a really smart paramedic and say, “You have a 6 month old female in cardiac arrest. She is 8 kg. Draw up the correct dose of Epi 1:10,000. Please hurry.”

Even if the paramedic realizesÂ the correct does is 0.8 ml of Epi 1:10,000 has he or she ever used a 1 ml syringe to draw epinephrine from 10 ml pre-filled syringe of Epi 1:10,000? Probably not. Now imagine doing it in front of the child’s parent. Can you see how vulnerableÂ System 2 is to the crash and burn?

Whatever we do it mustÂ be fast, simple, accurate, and achievable. We must convert these things into System 1 processes or we will not be able to pull them off on an emergency scene.

That is the basis of Dr. Antevy’s Pediatric Emergency StandardsÂ (Facebook).Â I urge you to check it out for the benefit of your EMS system and the children in your community. If EMS doesÂ not perform an effective resuscitation at the scene it is likely that the child will not survive.

Congratulations to Dr. Antevy on his EMS 10 Award! I’m looking forward to brining this back to my EMS system.

JEMS Games Finals

From there it was off to the JEMS Games Finals. What an amazing job! The scenario included a helicopter crash, multiple traumas, a swarm or angry bees, and acute anaphylaxis. The finalists included Boca Raton Team B, FDNY EMS, and Cumberland County EMS.

All three teams did an amazing job! The judges definitely have their work cut out for them! Keep your eyes on the #EMSToday2015 hashtag on Twitter. The winner will be announced very soon!

Kelly and I headed out to the Bubba Gump Shrimp Co. for the ZOLL Blogger Bash. It was great seeing some familiar faces in this time honored tradition. I even got caught up with Tim NoonanÂ the Rogue Medic! Ted Setla (@setla) was already there after doing a ride along with our good friend Random Ward (@WmRandomWard) who is a paramedic with Baltimore Fire. Ted took some awesome pictures as usual!

I got to talk shop a little bit with the folks at ZOLL (@zollemsfire) and explain to them our needs when it comes to post-event analysis and entering cardiac arrest data into the CARES registry. As always, they were interested in what they can do to make their products even better to meet the needs of the EMS market! Special thanks to Charlotte for inviting Kelly and me!

A Very Serious Topic

As we so often do we ended up back at the Pratt Street Ale House where Ted, Kelly, and IÂ ran into Mike McEvoy (@mcevoymike) and Jon B. (@EMTLife). We ended up discussing EMT and paramedic suicide.Â This is a difficult topic, and let’s face it, we in EMS are bunch of jaded, sarcastic, and twisted individuals who have developed all sorts of defensive mechanisms, including dark humor, to cope with our extraordinarily difficult jobs. I’d be lying if I said this conversation was any different.

But we must have this conversation.

Too many of us in the emergency services are ending our own lives. I vow to go back to my department and be a better friend and a better listener to my coworkers. I want to let them know that I care and that they matter to me individually. I hope you will all do the same. None of us really knows the burden other people carry with them. A single kind word can be a powerful force. Who knows? It might just be the thing that makes the difference.

Ken Grauer58 Year Old Male, Workout Worry@ Eli — I don’t see AFlutter. That is, I see no indication of regular atrial activity at a rate consistent with AFlutter. Instead, the rhythm is irregularly irregular without P waves = AFib at a controlled ventricular response. In my opinion, one doesn’t need Sgarbossa criteria here to activate the cath lab. So, yes the…
2018-09-13 02:09:24

Vince DiGiulioIs epinephrine harmful in cardiogenic shock?Sorry about that; I copied the quote from the article and my browser automatically changed the "μ" to an "m". Thanks for noticing, and thanks for pointing it out in the most passive-aggressive manner possible.
2018-09-12 16:45:26

Ken Grauer, MDElectrocardiographically Silent High Lateral STEMI EquivalentHi Tom. This is a great case — so NICE that you posted it for others to learned from. But as I commented several times when you sent this case around to our group — the T waves in V2,V3 are disproportionately peaked and transition occurs early (between V1-to-V2) — so the chest leads are NOT…
2018-08-14 08:38:03

Eli58 Year Old Male, Workout WorryAnybody else see the possibility of a LBBB or A-Flutter? I'm not sure if this will make any difference with the treatments but im just trying to interpret it first because if there is a LBBB then it does not meat Sgarbossa criteria and if it is A-Flutter that could explain the hyper acute T's…
2018-07-20 21:29:21